v

DAFTAR ISI

HALAMAN JUDUL ................................................................................. i

LEMBAR PENGESAHAN ........................................................................ ii

PERNYATAAN .......................................................................................... iii

KATA PENGANTAR ............................................................................... iv

DAFTAR ISI ............................................................................................... v

DAFTAR GAMBAR .................................................................................. viii

DAFTAR TABEL ..................................................................................... ix

INTISARI .................................................................................................. x

ABSTRACT .............................................................................................. x

i

BAB I. PENDAHULUAN ........................................................................ 1

A. Latar Belakang Penelitian ...................................................... 1

B. Perumusan Masalah ................................................................ 3

C. Tujuan Penelitian .................................................................... 4

D. Keaslian Penelitian ................................................................. 4

E. Manfaat Penelitian .................................................................. 7

BAB II. TINJAUAN PUSTAKA .............................................................. 8

A. Penyakit Paru Obstruktif Kronik ............................................ 8

1. Definisi Penyakit Paru Obstruktif Kronik ............................ 8

2. Patofisiologi Penyakit Paru Obstruktif Kronik .................. 8

3. Diagnosis Penyakit Paru Obstruktif Kronik ....................... 13

4. Penatalaksanaan Penyakit Paru Obstruktif Kronik ............ 14

a. Edukasi .......................................................................... 15

b. Terapi Farmakologis ...................................................... 15

c. Terapi Oksigen ............................................................... 17

d. Ventilasi Mekanik ......................................................... 17

e. Nutrisi ............................................................................ 18

f. Rehabilitasi ..................................................................... 19

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B. Pursed Lips Breathing (PLB) ................................................... 19

1. Definisi Pursed Lips Breathing (PLB) ................................ 19

2. Tujuan Pursed Lip Breathing (PLB) ................................... 20

3. Teknik Pursed Lip Breathing (PLB) ................................... 20

4. Durasi dan Dosis Pursed Lip Breathing (PLB) ................... 21

5. Manfaat Efek Pursed Lip Breathing (PLB) ........................... 23

C. BODE Index ............................................................................. 23

1. Body-Mass Index / Indeks Massa Tubuh .............................. 25

2. The Degree of Airflow Obstruction ...................................... 27

3. Sesak Nafas / Dyspneu ......................................................... 28

4. Exercise Capacity dengan Uji Jalan Jarak tempuh 6 menit . 29

D. Kerangka Teori Penelitian ........................................................ 33

E. Kerangka Konsep ...................................................................... 34

F. Hipotesis Penelitian ................................................................... 34

D. Kerangka Teori Penelitian ........................................................ 33

E. Kerangka Konsep ...................................................................... 34

F. Hipotesis Penelitian ................................................................... 34

BAB III. METODE PENELITIAN ........................................................... 35

A. Rancangan Penelitian ........................................................... 35

B. Tempat dan Waktu Penelitian .............................................. 35

C. Populasi Penelitian ............................................................... 35

D. Subyek Penelitian ................................................................. 36

E. Sampel Penelitian ................................................................. 37

F. Variabel Penelitian ................................................................ 38

G. Definisi Operasional ............................................................ 38

H. Protokol Penelitian ............................................................... 42

I. Alur Penelitian ....................................................................... 44

J. Analisis Statistik .................................................................... 44

K. Pertimbangan Etika dan Perizinan Penelitian ...................... 45

BAB IV. HASIL DAN PEMBAHASAN ................................................. 46

A. Hasil ..................................................................................... 46

1. Karakteristik Dasar Subyek Penelitian .............................. 47

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2. Deskripsi Variabel BODE Index Sebelum dan Sesudah

perlakuan .......................................................................... 50

3. Perubahan Variabel BODE Index .................................... 52

a. Perubahan Indeks Massa Tubuh ............................... 52

b. Perubahan Forced Expiration 1 Second prediksi ..... 53

c. Perubahan Skor mMRC Dyspnea Scale ................... 53

d. Perubahan Jarak Tempuh dengan Uji 6MWD ............ 53

4. Deskripsi Skor BODE Index.............................................. 54

B. Pembahasan ......................................................................... 57

1. Pursed Lips Breathing dan Indeks Massa Tubuh ............ 58

2. Pursed Lips Breathing dan Airflow Obstruction ............. 61

3. Pursed Lips Breathing dan Dyspnea ............................... 63

4. Pursed Lips Breathing dan Exercise dengan Uji 6MWD .. 65

5. Pursed Lips Breathing dan BODE Index ...................... 67

BAB V. KESIMPULAN DAN SARAN ................................................... 71

A. Kesimpulan ............................................................................ 71

B. Saran ....................................................................................... 71

DAFTAR PUSTAKA ............................................................................... 72

Lampiran 1. Informed Consent ................................................................. 77

Lampiran 2. Data dan Formulir Peserta Penelitian ................................... 80

Lampiran 3. Protokol Teknik Pursed Lips Breathing ............................... 82

Lampiran 4. Lembaran Catatan Harian ..................................................... 84

viii

DAFTAR GAMBAR

Gambar 1. Teknik Pursed-lip Breathing (PLB) .......................................... 21

Gambar 2. Kerangka Teori ........................................................................ 33

Gambar 3. Kerangka Konsep ...................................................................... 34

Gambar 4. Rancangan Penelitian ................................................................ 35

Gambar 5. Alur Penelitian ......................................................................... 44

Gambar 6. Alur Subyek Penelitian ............................................................ 46

Gambar 7. Scatterplot : Analisis Korelasi Pearson ..................................... 56

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DAFTAR TABEL

Tabel 1. Keaslian Penelitian ........................................................................... 5

Tabel 2. Indikator Variabel Diagnosis PPOK................................................... 14

Tabel 3. Klasifikasi Derajat Keparahan Hambatan Aliran Udara pada pasien

PPOK ................................................................................................ 14

Tabel 4. Tatalaksana Farmakologis Pasien PPOK ........................................... 16

Tabel 5. Durasi dan Dosis Pursed-lip Breathing pada Penelitian lain. ............ 22

Tabel 6. Variabel dan Nilai Ukur BODE Index ............................................. 25

Tabel 7. Klasifikasi Quartil BODE Index ........................................................ 25

Tabel 8. mMRC Dyspnea Scale ....................................................................... 28

Tabel 9. Faktor Yang Mempengaruhi Hasil Uji 6MWD .................................. 32

Tabel 10. Definisi Operasional ......................................................................... 38

Tabel 11. Karakteristik Subyek Penelitian ........................................................ 48

Tabel 12. Deskripsi Variabel BODE Index Sebelum dan Sesudah Perlakuan . 51

Tabel 13. Perubahan Variabel BODE Index Sebelum dan Sesudah Perlakuan .. 52

Tabel 14. Deskripsi Skor BODE Index Sebelum dan Sesudah Perlakuan ........ 55

Tabel 15. Perubahan Skor BODE Index ........................................................... 55